الفهرس 
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Abstract
The study included 54 patients, 39 with bladder carcinoma and 15
with benign bladder lesions, addition 15 healthy volunteers were enrolled
in the study.
All were subjected to: serologic schistosomiasis antibody assay,
urine cytology, detection of urinary HIF-1α, and detection of tissue CD34
in 30 malignant cases.
Results of the current study revealed that the mean age of the
bladder cancer was 61 ±10.
There was significant correlation between cigarette smoking and
bladder cancer (P≤ 0.012).
Malignant cases revealed Bilharzial antibodies in 64%, and was
statistically significante (P=0.001) between the three groups of the study
(Malignant, benign and control). On the other hand, bilharzial antibodies
was positive more than half the malignant group.
The correlation of the frequency of malignancy with the different
clinicopathological factors revealed association with male, positive
smokers, positive bilharziasis, TCC type and grade III.
Using ELISA assay, HIF-1α mean rank between the studied groups
showed highly significant difference (P=0.000).
In the present study CD34 expression did not show significant
correlation with tumor grade and stage.This may be due to the limited
number of cases.
The overall sensitivity of urine cytology was 53.8%, while its
specificity was 93.3% with 71% accuracy 91.3% PPV and 60.8% NPV.On
the other hand, a sensitivity of 84.6% and specificity of 63.3% with 75.3%
accuracy were observed for urinary HIF-1α. PPV was 75% and NPV was
76%.
By combining urinary HIF-1α assayed and cytology, sensitivity
increased significantly to be 94.8% and accuracy also increased to
82.6%.However specificity decreased to become 66.7%.
Furthermore HIF-1α also proved to be a good urinary tumor
marker for high grades and stages.
Urinary HIF-1α showed marked differentiation between malignant,
benign and healthy normal groups. The combined use of cytology and
HIF-1α increases the sensitivity of urine cytology from 53.8% to 94.8%
and accuracy from 71.0% to 82.6%. However their use in diagnosis of
bladder cancer can not replace cystoscopy but it can decrease the number
of cystoscopies during follow up and screen population at high risk for
bladder cancer so we recommended their use with cystoscopy during
follow up cases to detect any recurrence.